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目的 :评价耐碳青霉烯肠杆菌科细菌感染患者全因死亡风险。方法 :检索Pubmed数据库、Embase数据库,并辅以文献追溯、手工检索,检索时间为2001年1月1日至2015年12月31日。纳入同时含有碳青霉烯耐药肠杆科细菌(CRE)及碳青霉烯敏感的肠杆菌细菌(CSE)的临床特征及预后的研究。采用Stata14.0软件进行文献数据进行分析,并评价Meta分析结果的稳定性和发表偏倚。结果:16项研究符合纳入标准,包括2 916例患者(CRE感染797例,CSE 2 119例)。根据纳入研究的设计类型分为队列研究、病例对照研究;根据感染患者细菌检出的标本类型分为血流感染组亚组、综合感染类型亚组(包括尿液、血液、痰等)。队列研究组的CRE感染全因死亡的相对危险度(risk ratio,RR)为2.44(95%CI:1.96~3.03,I2=16.1%,P_(heterogeneity)=0.312);血流感染亚组的RR为2.07(95%CI:1.59~2.69,I2=0.0%,P_(heterogeneity)=0.511);综合感染类型亚组的RR为3.35(95%CI:2.25~4.99,I2=0.0%,P_(heterogeneity)=0.868)。病例对照组的比值比(odds ratio,OR)为2.30(95%CI:1.49~3.55,I2=53.5%,P_(heterogeneity)=0.018);血流感染亚组的OR为2.85(95%CI:1.66~4.90,I2=60.8%,P_(heterogeneity)=0.018);综合感染类型亚组的OR为1.46(95%CI:0.73~2.90,I2=25.2%,P_(heterogeneity)=0.261)。结论 :CRE患者病死率明显高于CSE患者,血流感染与患者死亡是密切相关的。
PURPOSE: To evaluate the risk of all-cause mortality in patients with Enterobacteriaceae resistant to carbapenem. Methods: The Pubmed database and Embase database were retrieved and searched by literature. The retrieval time was from January 1, 2001 to December 31, 2015. To investigate the clinical features and prognosis of carbapenem-resistant Enterobacteriaceae (CRE) and carbapenem-sensitive enterobacteriaceae (CSE). Stata14.0 software was used to analyze the literature data and evaluate the stability and publication bias of Meta analysis. Results: Sixteen studies met the inclusion criteria, including 2 916 patients (797 CRE and 119 119 CSE). According to the type of design included in the study, cohort studies and case-control studies were conducted. According to the types of specimens detected by the bacteria in the infected patients, they were divided into subgroups of bloodstream infections and subgroups of integrated infection types (including urine, blood and sputum). The risk ratio (RR) of all-cause death from CRE infection in cohort was 2.44 (95% CI: 1.96-3.03, I2 = 16.1%, P <0.05) Was 2.07 (95% CI: 1.59-2.69, I2 = 0.0%, P <0.05). The RR of the subgroup with integrated infection type was 3.35 (95% CI: 2.25-4.99, I2 = 0.0%, P heterogeneity ) = 0.868). The odds ratio (OR) was 2.30 in the case control group (95% CI: 1.49-3.55, I2 = 53.5%, P <0.05). The OR of the bloodstream infection subgroup was 2.85 1.66-4.90, I2 = 60.8%, and P heterogeneity = 0.018). The OR of the subgroup with integrated infection type was 1.46 (95% CI: 0.73-2.90, I2 = 25.2%, and heterogeneity = 0.261). Conclusion: The mortality of CRE patients is significantly higher than that of patients with CSE. The bloodstream infection is closely related to the death of patients.